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<h1 class="p_Heading1"><span class="f_Heading1">HIV Care Static Form: Initial Evaluation</span></h1>

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<p>&nbsp;</p>
<div style="text-align: left; text-indent: 0px; padding: 0px 0px 0px 0px; margin: 0px 0px 0px 10px;"><table style="width:923px; border:none; border-spacing:0px; border-collapse:collapse;">
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<td colspan="9" style="vertical-align:top; width:467px; height:17px; padding:4px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Initial Evaluation Business Rules</span></p>
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<td colspan="2" style="vertical-align:top; height:15px; padding:4px; border:solid 1px #000000;"><p><span style="font-weight: bold;">General Rules:</span></p>
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<td colspan="9" style="vertical-align:top; width:258px; height:15px; padding:4px; border:solid 1px #000000;"><p>If a patient is reactivated, the physician can fill out a new IE form (or a FU form); and therefore there can be more than one instance of the IE form in IQCare</p>
</td>
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<tr style="text-align:left;vertical-align:top;">
<td colspan="3" style="vertical-align:top; height:15px; padding:4px; border:solid 1px #000000;"><p>Paperless: ARV Therapy is not a required field</p>
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<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><br />
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<td style="vertical-align:top; width:45px; height:54px; padding:4px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Form No.</span></p>
</td>
<td style="vertical-align:top; width:93px; height:54px; padding:4px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Form Label</span></p>
</td>
<td style="vertical-align:top; width:154px; height:54px; padding:4px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Database Table</span></p>
</td>
<td style="vertical-align:top; width:74px; height:54px; padding:4px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Field Name</span></p>
</td>
<td style="vertical-align:top; width:209px; height:54px; padding:4px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Business Rule</span></p>
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<td style="vertical-align:top; width:52px; height:54px; padding:4px; border:solid 1px #000000;"><p><span style="font-weight: bold;">De-identified Field</span></p>
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<td style="vertical-align:top; width:64px; height:54px; padding:4px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Required for Saving</span></p>
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<td style="vertical-align:top; width:73px; height:54px; padding:4px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Minimum Reporting</span></p>
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<td style="vertical-align:top; width:69px; height:54px; padding:4px; border:solid 1px #000000;"><p><span style="font-weight: bold;">Minimum Clinical</span></p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>1</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>First Name</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>mst_Patient </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>FirstName</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Auto filled</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>1</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Last Name</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>mst_Patient </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>LastName</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Auto filled</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>2</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Visit Date</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>ord_Visit </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>VisitDate</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>Date on which the patient came into the clinic.<br />
No future dates allowed - like 2020</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>3</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>ID - Country</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>mst_Facility </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>CountryID</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Auto filled</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>3</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>ID - LPTF#</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>mst_Facility </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>PosID</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Auto filled</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>3</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>ID - Satellite #</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>mst_Facility </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>satelliteID</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Auto filled</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>3</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>ID - Patient Enrollment Number</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>mst_Patient </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>PatientEnrollmentID</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>Auto filled</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>3</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Existing Hosp/Clinic #</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>mst_Patient </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>PatientClinicID</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Auto filled</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>5a</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Date of HIV diagnosis</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientClinicalStatus </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>DateHIVDiagnosis</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>5b</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Diagnosis verified</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientClinicalStatus </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>HIVDiagnosisVerified</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>It’s a yes, no field</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:45px; padding:4px; border:solid 1px #000000;"><p>6</p>
</td>
<td style="vertical-align:top; width:93px; height:45px; padding:4px; border:solid 1px #000000;"><p>Disclosed</p>
</td>
<td style="vertical-align:top; width:154px; height:45px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientClinicalStatus </p>
</td>
<td style="vertical-align:top; width:74px; height:45px; padding:4px; border:solid 1px #000000;"><p>Disclosure</p>
</td>
<td style="vertical-align:top; width:209px; height:45px; padding:4px; border:solid 1px #000000;"><p>Although this is a similar question to the HIV Disclosure status quesiton on the Enrollment form, it is handled separately.</p>
</td>
<td style="vertical-align:top; width:52px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:90px; padding:4px; border:solid 1px #000000;"><p>6</p>
</td>
<td style="vertical-align:top; width:93px; height:90px; padding:4px; border:solid 1px #000000;"><p>Who to</p>
</td>
<td style="vertical-align:top; width:154px; height:90px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientClinicalStatus </p>
</td>
<td style="vertical-align:top; width:74px; height:90px; padding:4px; border:solid 1px #000000;"><p>DisclosureName</p>
</td>
<td style="vertical-align:top; width:209px; height:90px; padding:4px; border:solid 1px #000000;"><p>This should be a select box with the same options as for the field: dtl_PatientHivOther::HIVDisclosure &nbsp;Because this is a text box on the IE form, there is a possiblilty that different information may be entered than in the select box. The data entry person have to update the master table appropriately.</p>
</td>
<td style="vertical-align:top; width:52px; height:90px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:90px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:90px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:90px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:45px; padding:4px; border:solid 1px #000000;"><p>7</p>
</td>
<td style="vertical-align:top; width:93px; height:45px; padding:4px; border:solid 1px #000000;"><p>Pregnant</p>
</td>
<td style="vertical-align:top; width:154px; height:45px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientClinicalStatus </p>
</td>
<td style="vertical-align:top; width:74px; height:45px; padding:4px; border:solid 1px #000000;"><p>Pregnant</p>
</td>
<td style="vertical-align:top; width:209px; height:45px; padding:4px; border:solid 1px #000000;"><p>The field should only display or be editable (can gray out) if the patient has Gender=female</p>
<p>This should be defaulted to &quot;No&quot;</p>
</td>
<td style="vertical-align:top; width:52px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:45px; padding:4px; border:solid 1px #000000;"><p>Yes - if female</p>
</td>
<td style="vertical-align:top; width:69px; height:45px; padding:4px; border:solid 1px #000000;"><p>Yes - if female</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>7</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>LMP</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientClinicalStatus </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>LMP</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>LMP= Last Menstral Period</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p>Yes - if female</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Presenting Complaints</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>8</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Presenting Complaints</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientSymptoms </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>SymptomID</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>Default the UI to None; if other complaints are selected, None becomes de-selected.</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Medical History</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:165px; padding:4px; border:solid 1px #000000;"><p>10</p>
</td>
<td style="vertical-align:top; width:93px; height:165px; padding:4px; border:solid 1px #000000;"><p>Medical History - None, Liver, Kidney, Anaemia, etc.</p>
</td>
<td style="vertical-align:top; width:154px; height:165px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientDisease</p>
</td>
<td style="vertical-align:top; width:74px; height:165px; padding:4px; border:solid 1px #000000;"><p>DiseasePresent</p>
</td>
<td style="vertical-align:top; width:209px; height:165px; padding:4px; border:solid 1px #000000;"><p>No UI defaults<br />
1) If None is selected, then Liver, kidney, anemia and drug/alcohol abuse are given the answer of “none’ or null; <br />
2) If one or more diseases are selected, and the others are not filled out, then the others get &quot;none&quot;. (or only those that get filled in reside in the databae with the assumption that if it is not captured, then the value is &quot;none&quot;)<br />
3) If nothing is selected, then the Not Documented button must be selected.</p>
</td>
<td style="vertical-align:top; width:52px; height:165px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:165px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:165px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:165px; padding:4px; border:solid 1px #000000;"><p>None, filled in data, or Not documented</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>10</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Disease</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientDisease</p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>Disease_Pk</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>10</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Disease year</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientDisease</p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>DateOfDisease</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>For each new year, the current year is added to the list.</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>11</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Allergies -- None</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientAllergy </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>AllergyID</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Allergies -- Not documented</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:45px; padding:4px; border:solid 1px #000000;"><p>11</p>
</td>
<td style="vertical-align:top; width:93px; height:45px; padding:4px; border:solid 1px #000000;"><p>Allergies - Sulfa drugs</p>
</td>
<td style="vertical-align:top; width:154px; height:45px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientAllergy </p>
</td>
<td style="vertical-align:top; width:74px; height:45px; padding:4px; border:solid 1px #000000;"><p>AllergyID</p>
</td>
<td style="vertical-align:top; width:209px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:45px; padding:4px; border:solid 1px #000000;"><p>None, Yes, or Not documented</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>11</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Allergies -- Other (specify)</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientAllergy </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>AllergyID</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:45px; padding:4px; border:solid 1px #000000;"><p>12</p>
</td>
<td style="vertical-align:top; width:93px; height:45px; padding:4px; border:solid 1px #000000;"><p>Long Term Medications - Sulfa/TMP</p>
</td>
<td style="vertical-align:top; width:154px; height:45px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:45px; padding:4px; border:solid 1px #000000;"><p>LongTermMedsSulfa</p>
</td>
<td style="vertical-align:top; width:209px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:45px; padding:4px; border:solid 1px #000000;"><p>None, Yes, or Not documented</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>12</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Long Term Medications - TB Rx (specify)</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>LongTermTBMed</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>12</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Long Term Medications - TB Date</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>LongTermTBStartDate</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>12</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Long Term Medications - Other1, Other2 Description</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>longTermMedsOther1Desc</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>Two &quot;other long term meds&quot; available</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>HIV Related History</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>13</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Lowest CD4 Count</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>PrevLowestCD4</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Units = c/mm3</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>13</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Lowest CD4 Percent</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>PrevLowestCD4Percent</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Whole number, no decimals; should not execeed 99%</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>13</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Lowest CD4 Date</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>PrevLowestCD4Date</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>13b</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>CD4 prior to starting ARV Count</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>PriorARVsCD4</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>13b</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>CD4 prior to starting ARV Percent</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p> PrevARVScd4pRECENT</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>13b</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>CD4 prior to starting ARV Date</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>PriorARVsCD4Date</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>14</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Most recent CD4<br />
Last CD4 Count</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>MostRecentCD4</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>Check that this date is before the visit date.</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p>14</p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Most Recent CD4 Percent</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>MostRecentCD4Percent</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Whole number, no decimals; should not execeed 99%</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>14</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Most recent CD4 Date<br />
Last CD4 Count Date</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>MostRecentCD4Date</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>15</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Pre-therapy Viral Load<br />
Last Viral Load</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>MostRecentViralLoad</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>Whole number, no decimals</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>15</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Pre-therapy Viral Load Date<br />
Last Viral Load Date</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>MostRecentViralLoadDate</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:90px; padding:4px; border:solid 1px #000000;"><p>16</p>
</td>
<td style="vertical-align:top; width:93px; height:90px; padding:4px; border:solid 1px #000000;"><p>ARV exposure - None</p>
</td>
<td style="vertical-align:top; width:154px; height:90px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:90px; padding:4px; border:solid 1px #000000;"><p>PrevARVExposure</p>
</td>
<td style="vertical-align:top; width:209px; height:90px; padding:4px; border:solid 1px #000000;"><p>Do not default UI to None.<br />
If None has be select and any other of the fields in this section are filled in, None becomes unchecked.<br />
If other fields are filled in and None is then checked, an alert message appear notifying the user that the fields will be cleared.</p>
</td>
<td style="vertical-align:top; width:52px; height:90px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:90px; padding:4px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:73px; height:90px; padding:4px; border:solid 1px #000000;"><p>Yes <br />
Either &quot;none&quot;, &quot;single dose NVP&quot; or &quot;ARVs&quot; must be selected</p>
</td>
<td style="vertical-align:top; width:69px; height:90px; padding:4px; border:solid 1px #000000;"><p>Yes - if none other in this section selected</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:90px; padding:4px; border:solid 1px #000000;"><p>16</p>
</td>
<td style="vertical-align:top; width:93px; height:90px; padding:4px; border:solid 1px #000000;"><p>Historical ART</p>
</td>
<td style="vertical-align:top; width:154px; height:90px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:90px; padding:4px; border:solid 1px #000000;"><p>Previous ART</p>
</td>
<td style="vertical-align:top; width:209px; height:90px; padding:4px; border:solid 1px #000000;"><p>Use of drug helper which allows the User to select the drugs that make up the regimen</p>
</td>
<td style="vertical-align:top; width:52px; height:90px; padding:4px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:64px; height:90px; padding:4px; border:solid 1px #000000;"><p>Yes if Previous ARV exposure not equal to &quot;None&quot;</p>
</td>
<td style="vertical-align:top; width:73px; height:90px; padding:4px; border:solid 1px #000000;"><p>Yes if Previous ARV exposure not equal to &quot;None&quot;</p>
</td>
<td style="vertical-align:top; width:69px; height:90px; padding:4px; border:solid 1px #000000;"><p>Yes if Previous ARV exposure not equal to &quot;None&quot;</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:105px; padding:4px; border:solid 1px #000000;"><p>16</p>
</td>
<td style="vertical-align:top; width:93px; height:105px; padding:4px; border:solid 1px #000000;"><p>Historical Start Date</p>
</td>
<td style="vertical-align:top; width:154px; height:105px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:105px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:105px; padding:4px; border:solid 1px #000000;"><p>mm/yy</p>
</td>
<td style="vertical-align:top; width:52px; height:105px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:105px; padding:4px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:73px; height:105px; padding:4px; border:solid 1px #000000;"><p>Yes<br />
We need to know whether they have been on ART for the last three months</p>
</td>
<td style="vertical-align:top; width:69px; height:105px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:90px; padding:4px; border:solid 1px #000000;"><p>16</p>
</td>
<td style="vertical-align:top; width:93px; height:90px; padding:4px; border:solid 1px #000000;"><p>Previous Single dose NVP</p>
</td>
<td style="vertical-align:top; width:154px; height:90px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:90px; padding:4px; border:solid 1px #000000;"><p>PrevSingleDoseNVP</p>
</td>
<td style="vertical-align:top; width:209px; height:90px; padding:4px; border:solid 1px #000000;"><p>Check box which opens two date fields</p>
</td>
<td style="vertical-align:top; width:52px; height:90px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:90px; padding:4px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:73px; height:90px; padding:4px; border:solid 1px #000000;"><p>Yes if Previous ARV exposure not equal to &quot;None&quot;</p>
</td>
<td style="vertical-align:top; width:69px; height:90px; padding:4px; border:solid 1px #000000;"><p>Yes if Previous ARV exposure not equal to &quot;None&quot;</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>16</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Previous Single dose NVP Date1</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>PrevSingleDoseNVPDate</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>mm/yy</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>16</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Previous Single dose NVP Date2</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>PrevSingleDoseNVPDate</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>mm/yy</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>16</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Regimen (Previous 1st Regimen Name)</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>PrevARVRegimen1Name</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>Select from drug list</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>16</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Regimen (Previous 1st Regimen Months)</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>PrevARVRegimen1Months</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>16</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Regimen (Previous 2nd Regimen Name)</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>PrevARVRegimen2Name</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>Select from drug list</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>16</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Regimen (Previous 2nd Regimen Months)</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>PrevARVRegimen2Months</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>16</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Regimen (Previous 3rd Regimen Name)</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>PrevARVRegimen3Name</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>Select from drug list</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>16</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Regimen (Previous 3rd Regimen Months)</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>PrevARVRegimen3Months</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>16</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Regimen (Previous 4th Regimen Name)</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>PrevARVRegimen4Name</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>Select from drug list</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p>16</p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Regimen (Previous 4th Regimen Months)</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientHivPrevCareIE </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>PrevARVRegimen4Months</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>HIV Associated Conditions</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:105px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:105px; padding:4px; border:solid 1px #000000;"><p>None, Pulmonary TB, Extrapulmonary TB, etc…</p>
</td>
<td style="vertical-align:top; width:154px; height:105px; padding:4px; border:solid 1px #000000;"><p>mst_HivDisease, dtl_PatientDisease </p>
</td>
<td style="vertical-align:top; width:74px; height:105px; padding:4px; border:solid 1px #000000;"><p>Disease_pk, DiseaseName</p>
</td>
<td style="vertical-align:top; width:209px; height:105px; padding:4px; border:solid 1px #000000;"><p>No UI defaults; Not document button required<br />
Pulmonary Smear + and Pulmonary Smear - separated out</p>
</td>
<td style="vertical-align:top; width:52px; height:105px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:105px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:105px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:105px; padding:4px; border:solid 1px #000000;"><p>Yes [none, conditions entered or not documented must be filled in]</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Physical Exam</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td colspan="3" style="vertical-align:top; width:147px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Temp (Degrees C)</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>Temp (deg C)</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Field level validation boundaries: 30.0-50.0</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>RR (cpm)</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>RR</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Field level validation boundaries: 4-100</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>HR (bpm)</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>HR</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Field level validation boundaries: 30-200</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>BP Systolic (mm/Hg)</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>BPSystolic</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Field level validation boundaries: 50-250</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>BP Diastolic (mm/Hg)</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>BPDiastolic</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Field level validation boundaries: 30-150</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Ht (cm)</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>Height</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Field level valdiation boundaries: 0-250</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Wt (kg)</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>Weight</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Field level validation boundaries: 0-225</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Pain</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientVitals</p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>Pain</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>Pain is on a scale of 1 to 10.</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>WAB Stage</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientStage</p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>WABStage</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>[Working, Ambulatory, Bedridden]</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>WHO Stage</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientStage</p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>WHOStage</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p>I, II, III, IV]</p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Assessment</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Clinical Assessment - Initial Evaluation</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientAssessment </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>AssessmentID</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>Assessment options: No illness found, HIV-related illness/OI, Non-HIV-related illness</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Clinical Assessment Notes</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientAssessment </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>Description</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Treatment Plan</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Treatment Plan - Initial Evaluation</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientAssessment </p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>AssessmentID</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>Plan options: Lab evaluation/TB screen, OI Prophylaxis/treatment, Treatment Preparation, Other</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Treatment Plan Notes</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientAssessment </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>Description</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>ARV Therapy</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:45px; padding:4px; border:solid 1px #000000;"><p>Treatment not indicated now</p>
</td>
<td style="vertical-align:top; width:154px; height:45px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientArvTherapy</p>
</td>
<td style="vertical-align:top; width:74px; height:45px; padding:4px; border:solid 1px #000000;"><p>TherapyPlan</p>
</td>
<td style="vertical-align:top; width:209px; height:45px; padding:4px; border:solid 1px #000000;"><p>For non-paperless, this is a required field;<br />
For paperless, this is not a requied field.</p>
</td>
<td style="vertical-align:top; width:52px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:45px; padding:4px; border:solid 1px #000000;"><p>Yes, for non-paperless</p>
</td>
<td style="vertical-align:top; width:73px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Continue Current</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientArvTherapy</p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>TherapyPlan</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Restart Treatment</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientArvTherapy</p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>TherapyPlan</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Start New Treatment</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientArvTherapy</p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p>TherapyPlan</p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><br />
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Change regimen reason code</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientArvTherapy</p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>TherapyReasonCode</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>If currARVTherapy=Change treatment then TherapyReasonCode is required</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:30px; padding:4px; border:solid 1px #000000;"><p>Stop regimen reason code</p>
</td>
<td style="vertical-align:top; width:154px; height:30px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientArvTherapy</p>
</td>
<td style="vertical-align:top; width:74px; height:30px; padding:4px; border:solid 1px #000000;"><p>TherapyReasonCode</p>
</td>
<td style="vertical-align:top; width:209px; height:30px; padding:4px; border:solid 1px #000000;"><p>If currARVTherapy=Stop treatment then TherapyReasonCode is required</p>
</td>
<td style="vertical-align:top; width:52px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:30px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:15px; padding:4px; border:solid 1px #000000;"><p>Appointment Scheduling</p>
</td>
<td style="vertical-align:top; width:154px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:209px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:15px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:46px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:46px; padding:4px; border:solid 1px #000000;"><p>When is the patient's next appointment?</p>
</td>
<td style="vertical-align:top; width:154px; height:46px; padding:4px; border:solid 1px #000000;"><p>Dtl_Patientappointment</p>
</td>
<td style="vertical-align:top; width:74px; height:46px; padding:4px; border:solid 1px #000000;"><p>Appdate</p>
</td>
<td style="vertical-align:top; width:209px; height:46px; padding:4px; border:solid 1px #000000;"><p>This needs to be tied into the schedule. The date should be automatically calculated based on appointment period.</p>
</td>
<td style="vertical-align:top; width:52px; height:46px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:46px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:46px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:46px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:32px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:32px; padding:4px; border:solid 1px #000000;"><p>Next appointment date</p>
</td>
<td style="vertical-align:top; width:154px; height:32px; padding:4px; border:solid 1px #000000;"><p>Dtl_patientappointment</p>
</td>
<td style="vertical-align:top; width:74px; height:32px; padding:4px; border:solid 1px #000000;"><p>Appdate  </p>
</td>
<td style="vertical-align:top; width:209px; height:32px; padding:4px; border:solid 1px #000000;"><p>The date can be entered directly. If a date is entered, then appPeriod is Null.</p>
</td>
<td style="vertical-align:top; width:52px; height:32px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:32px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:32px; padding:4px; border:solid 1px #000000;"><p>Yes</p>
</td>
<td style="vertical-align:top; width:69px; height:32px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:32px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:32px; padding:4px; border:solid 1px #000000;"><p>Appointment Reason</p>
</td>
<td style="vertical-align:top; width:154px; height:32px; padding:4px; border:solid 1px #000000;"><p>Dtl_patientappointment</p>
</td>
<td style="vertical-align:top; width:74px; height:32px; padding:4px; border:solid 1px #000000;"><p> AppReason</p>
</td>
<td style="vertical-align:top; width:209px; height:32px; padding:4px; border:solid 1px #000000;"><p>This is a new field: reasons are “Follow up”; “Lab test”; and “Treatment Preparation”</p>
</td>
<td style="vertical-align:top; width:52px; height:32px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:32px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:32px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:32px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:16px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:16px; padding:4px; border:solid 1px #000000;"><p>Signature</p>
</td>
<td style="vertical-align:top; width:154px; height:16px; padding:4px; border:solid 1px #000000;"><p>dtl_PatientClinicalStatus </p>
</td>
<td style="vertical-align:top; width:74px; height:16px; padding:4px; border:solid 1px #000000;"><p>signature</p>
</td>
<td style="vertical-align:top; width:209px; height:16px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:52px; height:16px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:16px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:16px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:16px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
<tr style="text-align:left;vertical-align:top;">
<td style="vertical-align:top; width:45px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:93px; height:45px; padding:4px; border:solid 1px #000000;"><p>Print</p>
</td>
<td style="vertical-align:top; width:154px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:74px; height:45px; padding:4px; border:solid 1px #000000;"><p>Print</p>
</td>
<td style="vertical-align:top; width:209px; height:45px; padding:4px; border:solid 1px #000000;"><p>This button is used to take hard copy of the form. This is basically feature of paperless, but is implemented for non paperless too</p>
</td>
<td style="vertical-align:top; width:52px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:64px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:73px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
<td style="vertical-align:top; width:69px; height:45px; padding:4px; border:solid 1px #000000;"><p> </p>
</td>
</tr>
</table>
</div>

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